Enrollment Form towards Professional Certificate in Sexuality Education 

Thank you for your interest in my Professional Certificate in Sexuality Education! Details here.

Please complete the below and we will then schedule a time to speak via Zoom.

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Email *
Name *
Email address *
Phone number *
Emergency Contact Details *
Location *

1. What interests you in taking the training?

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2. What is your professional background (in relation to this training)?

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3. What experience or training do you have in working with people with sexual issues?

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4. Do you have any specific questions or curiosities that you would like the training to answer?

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5. What support services or processes do you engage in (such as seeing a counsellor, support groups, bodyworkers, friendship networks etc)?

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6. What do you think you might find challenging about the training?

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7. How do you envision making use of what you learn in the training?

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8. Please tell us about any physical or mental health issues you have. This is important for us to know about in order to support you in the learning process.

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9. If you are living with trauma, could you please provide a little more detail on how it currently affects you?

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10. If you are living with a disability, could you please provide a little more detail about the disability and how we can support your learning?

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11. Are there any medications or substances you take regularly?

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12. If you are in any process of recovery, for example from surgery, cancer, substance use, relationship break up, grief, psychosis or spiritual emergency, please tell us about it here:

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13. How did you hear about the training and what motivated you to contact us?

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14. Any other information you wish to provide?

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15. Please state three of your preferred dates/ times to schedule your virtual interview/ chat with Dr Martha Tara Lee. This will be a time to ask all your questions about the training. :) *
A copy of your responses will be emailed to the address you provided.
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